| Kaiser Foundation Health Plan Northern California |
| Dianeal Low Calcium/4.25% Dex (periton.dialysis 8-4.25 % dext) |
| Drugs for the Kidneys : Drugs for the Kidneys |
- Prior Authorization: Peanut Allergy:
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 4
Duration: 6 Month(s)
Reauthorization Required: Yes
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